title: Variation in cesarean section rates is not related to maternal and neonatal outcomes.
abstract: OBJECTIVE
  The aim of this study was to compare the rate of cesarean sections in 12 delivery units in Finland, and to assess possible associations between cesarean section rates and maternal and neonatal complications.
  
  
  METHODS
  Prospective multicenter cohort study.
  
  
  METHODS
  The 12 largest delivery units in Finland.
  
  
  METHODS
  Total obstetric population between 1 January 2005 and 30 June 2005 (n = 19 764).
  
  
  METHODS
  Prospectively collected data on 2496 cesarean sections and data derived from the Finnish Birth Register on all deliveries in these units were compared. Cesarean section rates and maternal complication rates were adjusted for known risk factors.
  
  
  METHODS
  Cesarean section rate, maternal complications related to cesarean section, and neonatal asphyxia.
  
  
  RESULTS
  The cesarean section rates varied significantly between the hospitals (12.9-25.1%, p < 0.0001), as did the maternal complication rates related to cesarean section (13.0-36.5%, p < 0.0001). There was no relation between maternal complications and the cesarean section rate. The differences remained after adjusting for risk factors. Neonatal asphyxia rates varied between 0.14 and 2.8% (p < 0.0001) and were not related to the cesarean section rates.
  
  
  CONCLUSIONS
  The rates of cesarean section, maternal complications and neonatal asphyxia vary markedly between different delivery units. Good maternal and neonatal outcomes can be achieved with cesarean section rates <15%.
authors.affiliation: Department of Obstetrics and Gynecology, Turku University Central Hospital, Turku, Finland.
authors.forename: Nanneli
authors.initials: N
authors.lastname: Pallasmaa
authors.forename: Anna
authors.initials: A
authors.lastname: Alanen
authors.forename: Ulla
authors.initials: U
authors.lastname: Ekblad
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.forename: Mari
authors.initials: M
authors.lastname: Koivisto
authors.forename: Tytti
authors.initials: T
authors.lastname: Raudaskoski
authors.forename: Veli-Matti
authors.initials: VM
authors.lastname: Ulander
authors.forename: Jukka
authors.initials: J
authors.lastname: Uotila
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors
keywords: Cesarean section rate; comparing obstetric care; maternal complications; neonatal asphyxia; quality of obstetric care